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Senior Clinical Quality Assurance Analyst

11 hours, 34 minutes ago
United States
Full-time
Senior
QA Engineer
Quality Assurance and Testing
Apply Now
Inovalon

Inovalon

Inovalon provides cloud-based platforms that facilitate a data-driven transformation in the healthcare industry, enabling organizations to enhance clinical outcomes and financial performance through advanced analytics and large-scale data interconnecti...

IT Services
1K-5K
Founded 1998
View All Jobs 11

Description

  • Assist with the development, organization, and implementation of companywide quality improvement efforts.
  • Monitor the quality and reliability of reporting mechanisms and management tools.
  • Analyze reviews and consolidate findings for reporting to senior leadership and other key stakeholders.
  • Ensure compliance with contractual, local, state, and national quality standards.
  • Support clinical product strategy through competitive research, peer comparisons, product and clinical research and development, and market opportunity analysis.
  • Support clinical product implementations so projects are delivered on time, within budget, and according to written specifications.
  • Develop and execute initial and ongoing training processes.
  • Maintain communication across the enterprise regarding ongoing overread and quality activity related to client and operations management.
  • Develop recommendations for process and technical changes and document them as applicable.
  • Assist in the development, execution, and management of internal and client-facing clinical auditing programs.
  • Support client relationships by addressing questions, concerns, and service issues and helping execute action plans.
  • Develop new policies, processes, and procedures aligned with clinical and organizational expectations.

Requirements

  • Minimum 2 years of ICD-10 diagnosis coding expertise, ideally 5+ years, with a deep understanding of coding guidelines and application.
  • Minimum 2 years of HEDIS quality measure experience with understanding of HEDIS rules, regulations, and hybrid measure development.
  • Risk adjustment coding expertise with understanding of risk adjustment methodologies and coding accuracy.
  • Hands-on experience with AI tools or AI training background, with demonstrated ability to understand AI capabilities and limitations.
  • 5+ years of clinical nursing background.
  • 5+ years in healthcare plan quality improvement initiatives preferred.
  • 5+ years working with public programs such as Medicare and Medicaid.
  • Authorized to work in the United States; immigration sponsorship is not available for this role.
  • Remote role with hybrid schedule required for employees living within 40 miles of the Tampa, FL; Canonsburg, PA; or Bowie, MD offices.

Benefits

  • Base compensation range of $84,600 to $110,000 USD.
  • Eligible for performance-based incentives.
  • Health insurance and life insurance options.
  • Company-paid disability coverage.
  • 401(k) retirement plan.
  • 18+ days of paid time off.
  • Remote work with a hybrid schedule for employees near select office locations.

Interested in this position?

Apply directly on the company website

Apply Now

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